Early Breast Cancer Management During the COVID-19 Pandemic: A Case Report
Posted: Monday, August 31, 2020
The COVID-19 pandemic has necessitated alternatives to the standard management of early breast cancers, due to the suspension of nonessential elective surgeries. Early on, providers turned their focus toward developing a multidisciplinary approach to cancer management, one that was amenable to modification in choice and sequence of treatment methodology while weighing the risk of COVID-19 transmission, with the ultimate goal of a cure.
“Ideally, the multidisciplinary team would include a surgical oncologist, a radiation oncologist, a medical oncologist, a genetics expert (if needed), a social worker (if needed), and a person with expertise in symptom management, palliative medicine, or both (if needed),” wrote the authors.
An illustrative case report, published in The New England Journal of Medicine by Beverly Moy, MD, MPH, of Massachusetts General Hospital, and colleagues, discussed the management of a patient described as a postmenopausal, 62-year-old Ashkenazi Jewish woman, diagnosed with clinical stage T2N0, hormone receptor-positive, HER2-negative breast cancer. Normally, such a patient would be a candidate for upfront surgery, followed by adjuvant chemotherapy, radiation therapy, or both.
During the COVID-19 pandemic, the sequence of treatments for this patient was reversed to include neoadjuvant endocrine therapy with an aromatase inhibitor, then timely follow-up to monitor potential cancer progression, and finally, if indicated, surgery, with or without adjuvant chemotherapy, radiation therapy, or both. At the time of publication, the patient had received neoadjuvant therapy and was doing well; she was awaiting her 2-month follow-up visit with the multidisciplinary team.
“During a clinical visit, identifying and addressing concerns and emotions are a key first step before proceeding to the other parts of the visit,” concluded the authors. “It is difficult for a patient to absorb medical information if the provider does not acknowledge any worry, anxiety, and distress about the diagnosis and the pandemic. At the start of the visit, checking in with the patient is important.”
Disclosure: Information on authors' disclosures can be found at nejm.org.
